HomeMy WebLinkAbout1000-87.-5-19.3 3
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TOWN OF SOUTHOL
Rental Permit
Permit No. 0068
Owner Jessica Bermingham & Thomas Beug
Occupied as Single Family Dwelling
Located at 1620 Koke Dr Southold 87-5-19.3
Address Village S/B/L
Maximum Permitted Occupancy 5
Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of
the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is
two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection.
5/29/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
llr� p110
Town Hall Annex Telephone(631)765-1802
54375 Main Road N , Fax(631)765-9502
P.O.Box 1179
0959
Southold,NY 11971 �m
BUILDING DEPARTMENT
TOWN OF SOUTHOILD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
.....
Section A.
Property Information:
Rental Property Address: '
Tax Map Number: 1000 SECTION 8 —BLOCK JOT ( q
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
RLI��
Telephone Number(s): 3 zce4 V 610C
Property Owner Email Address:
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:_
Address of Authorized Agent (no P.O. Boxes):—loom
"rJ "
Mailing Address of Authorized Agent:
Telephone Number(s): _
Email Address:
i . 0 CrA
Section D.
Managing Agent Information
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent (no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number (s):
Email Address:
SECTION E. N l oc
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes):
Mailing Address of Managing Agent:
Telephone Number(s):
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property:
For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example,
Unit 1, Unit 2, Unit 3 or Apt A, B, C);the use of each room in the Rental Dwelling Unit
(for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each
room.
For properties with multiple Rental Dwelling Units use "Rental Permit Application
Addendum."
Rental Dwelling Unit Identifier: K A I Q 1A o ...
Requested Maximum number of persons allowed to occupy Dwelling Unit.
Number of rooms in Rental Dwelling Unit: t
1��, ...
Use and Dimensions of each room in Rental Dwelling Unit: ����� �
°�cl 0 jb-a,00t.A 9L l
__ LO 0
SECTION G.
INSPECTION:
Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety
inspection by Code Enforcement Official is required. If the owner chooses not to have said
inspection performed by the Town, a certification from a NYS licensed architect, a NYS licensed
professional engineer or a home inspector who has a valid New Fork State Uniform Fire
Prevention Building Code. Certification is required stating that the property which is the subject
of the rental permit application is in compliance with all of the provisions of the code of the
Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and
by the laws adopted by the New York State Fire Prevention and Building Code Council.
i' 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold.
Page 3 of 4
�I am submitting a completed Town of Southold certification form from a licensed
architect, a licensed professional engineer,or a licensed home inspector who has a valid
New York State Uniform Fire Prevention Building code Certification.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
I certify under penalty of perjury,the following:
1. 1 am the owner of the property identified in "Section A" of this application.
2. The property owner's legal address set forth in "Section B" of this application is my legal
address and I understand the Town will use the address for service pursuant to all
applicable laws and rules. I further acknowledge that I will notify the Town of Southold
Building Department of any changes of address within five (5) days of any changes
thereto.
3. I have read and received a copy of Chapter 207 of the Code of the Town of Southold and
agreed to abide by the same.
4. 1 will notify the Town within five (5) business clays s to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name: _ ,
Property Owner's Signature:
.m_.v_.
Sworn to before me this day of
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Page 4 of 4
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 26303 Date: 02/26/99
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1620 KOKE DR SOU' HOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 087 Block 0005 Lot 019.003
Subdivision Filed Map NO. Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 26303 dated FEBRUARY 26 1999
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH COVERED FRONT PORCH, ENCLOSED REAR PORCH
AND ACCESSORY GARAGE.
The certificate is issued to HELEN GREENE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
v Buildi �"~Inspecto
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
LOCATION: —_,
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S) : ,
OCCUPANCY:
ADMITTED BY: ACCOMPANIED BY: SAME
KEY AVAILABLE: SUFF. CO. TAX MAP NO.:
SOURCE OF REQUEST: PAUL CAMINITI DATE: 02/26/99
DWELLING:
TYPE OF CONSTRUCTION: # STORIES: 7.0 # EXITS: �4
FOUNDATION: BRICK CELLAR: 7/8 CRAWL SPACE: 1/8
TOTAL ROOMS: 1ST FLR.: 2ND FLR. : -, 3RD FLR.: 0
BATHROOM(S) : 1.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S) :
PORCH TYPE: DECK TYPE: PATIO TYPE: ,
BREEZEWAY: FIREPLACE: NO GARAGE: ,
DOMESTIC HOTWATER: YES TYPE HEATER: QIL AIRCONDITIONING:
TYPE HEAT: BASEBOARD_ WARM AIR: HOTWATER: OIL
OTHER:
GARAGE, TYPE OF CONST.: *WOOD &:Ft= STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER: *
VIOLATIONS: CHAPTER 4S N.Y. STATE UNIFORM FIRE PREVENTION BUILDING CODE
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REMARKS: REINSp „
INSPECTED BY: DATE ON INSPECTION: 02/10/99
MICHAEL J. VERITY TIME START: 10:10 END: 10:50
y , FL+ Town of Southold 7/12/2018
P.O.Box 1179
CM
co 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39770 Date: 7/12/2018
THIS CERTIFIES that the building ADDI'ITION/AUr RATION
Location of Property: 1620 Koke Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 87.-5-19.3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/15/2016 pursuant to which Building Permit No. 40721 dated 5/25/2016
was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
SCREP'NI^D,F"QK 11 ADDIIION AND OUTDOOR SHOWER TO AN EXISTING ONE,FAMILY I)W .1,LING
PER HPC APPROVAL.AS APPLI D FOR
The certificate is issued to Jessica Bermingham&Thomas Beug
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40721 11-17-2016
PLUMBERS CERTIFICATION DATED
but 10 cc Signature
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28053 Date: 11/05/01
THIS CERTIFIES that the building FOUNDATION/FLR BEAM REP
Location of Property: 1620 KOKE DR SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 87 Block 5 Lot 19'.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 25, 1999 pursuant to which
Building Permit No. 26079-Z dated OCTOBER 26, 1999
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is NEW FOUNDATION & FLOOR BEAM REAPAIR FOR EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
The certificate is issued to MARC D HARRISON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL mm N/A
ELECTRICAL CERTIFICATE NO_ PENDING 0 28/01
PLUMBERS CERTIFICATION DATED 07/18/01 NORTH FORK PLUMBING
Authorized Sigrg ' ure
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31291 Date: 11 21/05
THIS CERTIFIES that the building ADDITION
Location of Property: 1620 KOKE DR SOUT_HOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473aB 9 Section 87 Block 5 Lot 19.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 6, 2005 pursuant to which
Building Permit No. 31121-Z dated MAY 10, 2005
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER
CONDITIONS OF ZBA #5674 DATED 4/14/05.
The certificate is issued to BERNARD SPRINGSTEEL & MARCIA POLLAK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 206114S 10 21/05
PLUMBERS CERTIFICATION DATED N/A
i
Authorized Signature
Rev. 1/81
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INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] F AL Qwllr�-
FIREPLACE & CHIMNEY [ FIRE' SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
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DATE INSPECTOR
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